Anomalous Left Anterior Descending Coronary Artery Arising from the Pulmonary Artery (ALADAPA): A Narrative Review and the 52nd Case in the World

Congenital coronary artery abnormalities are detected in 0.6 to 1% of adult patients having coronary angiography. Anomalous origin of coronary arteries from the pulmonary artery is a rare congenital anomaly that is almost always lethal if not diagnosed and treated. Only 51 cases of ALADAPA have been reported in the literature, with clinical presentations varying from sudden cardiac arrest to incidental murmur depending on the area of the myocardium affected. Case Presentation: A 32-year-old female who presented with unstable angina was diagnosed with an anomalous origin of the left anterior descending artery from the pulmonary artery (ALADAPA). The patient underwent uneventful coronary artery bypass grafting where the left internal mammary artery (LIMA) was anastomosed to the left anterior descending coronary artery (LAD) and the abnormal origin of ALDAPA was ligated. The patient’s symptoms improved remarkably. Computer-ized tomography coronary angiography performed six weeks postopera-tively showed patent LIMA to LAD.